Virtual care could be the great equalizer: Three case examples | Carrie Nelson

Pandemic-related hardships affect the mental and physical health of various populations differently.

Younger generations, women, and those with children in the home face higher rates of depression and anxiety, while Black and Hispanic adults fare worse than white adults across all health measures. Technology—particularly virtual care—could prove to be The Great Equalizer and raise the quality of care for all populations, if used properly.

Carrie Nelson

The best virtual care programs solve health access issues for medically underserved communities, resulting in significant improvements in disease control and treatment plan adherence. Seniors who are transitioning from in-hospital to in-home care, for example, could benefit from personal emergency response systems that enable them to reach a health specialist at the touch of a button. This could reduce readmissions and allow seniors to remain safely in their homes, thereby improving quality of life.

Tele-intake services for low-income populations suffering from substance use disorder or mental health conditions can extend the reach of emergency department (ED) staff to make referrals for ongoing care, potentially saving lives.

While the complexity of this work cannot be overstated—especially for populations with (justifiably) low levels of trust in the healthcare system—several successes of leading provider organizations and health plans point to practical ways we can apply digital care solutions to improve health for all.

Here are three lessons learned.

1. Map out regional resources that could serve as partners for virtual access.

In early 2022, the U.S. Department of Health and Human Services (HHS) awarded $55 million to community health centers to expand access to telehealth and digital technologies. Since the pandemic began, use of virtual care in community health centers has risen 6,000%, according to HHS. More programs like this are key to solving the digital divide.

While smartphone access is high even among vulnerable populations, most low-income populations find digital health apps difficult to use. A recent study found that for these populations, the idea of digital health apps is appealing, but data entry often is too cumbersome to make using these apps worthwhile.

Community service agencies, recreational centers and faith-based organizations could help bridge the gap between digital health usability and value—including for virtual care—by providing onsite assistance, education, and a friendly presence to turn to when questions arise. This could also help solve for issues with broadband access that pose barriers to telehealth use for 45% of individuals surveyed who have used telehealth at least once.

2. Look for ways to leverage care managers for education on digital chronic care management.

Self-management of chronic conditions such as diabetes and heart disease requires not just access to medical care, but also savvy consumer engagement approaches, understandable education and next-level behavior modification tools. Many digital solutions check these boxes.

However, digital chronic condition management must incorporate sensitivities to cultural, social, and economic barriers. This is an area where a care management team can bolster engagement by providing insight and support for engaging populations that may be reluctant or have barriers to trying a new health approach.

Language preferences can be addressed with technology. For instance, even before the pandemic, clinicians at Massachusetts General Hospital were concerned that telehealth disenfranchised a large portion of the population—particularly those with limited English proficiency.

When COVID-19 emerged, they worked to increase access to virtual care and technologies for these patients. They provided interpreters who could ease the process of connecting with a virtual provider to receive timely care and address the privacy concerns of immigrant patients. They also offered patient education around virtual platforms and technologies in multiple languages.

“We really had to put ourselves in the patient’s shoes and walk through all workflows to make sure language and health literacy needs were being addressed,” senior author Esteban A. Barreto, PhD, MA, director of Evaluation of Equity and Community Health at Massachusetts General, said in a release.

3. Use digital mechanisms to strengthen existing healthcare relationships.

MetroPlus Health Plan in New York City used text messaging to drive telehealth registration rates during the height of the pandemic. The health plan, which serves more than 550,000 members—72% of whom are covered by Medicaid, a notoriously hard population to reach—launched its virtual care program during the pandemic and in less than three months, engaged nearly 7,000 members in telehealth. MetroPlus did this by communicating with members via the digital tool they use most—their smartphone—using interactive voice response calls and SMS texts to drive telehealth registration.

At Advocate Aurora Health, care managers used a digital solution to monitor COVID-19 patients discharged from the ED or from an inpatient stay to ensure safe recovery at home. Outreach enabled through this technology allowed nurses to know when a patient’s condition worsened, and they needed to return to in-person care. For those living in social isolation, the patient experience was especially remarkable. Comments such as “I didn’t feel so alone” validated the approach even beyond its clinical utility. 

Another opportunity to strengthen existing healthcare relationships is with automated questionnaires that help identify SDoH at the point of care. Some patients are more willing to share information regarding SDoH via a digital mechanism rather than during a personal encounter. Automated questionnaires can help providers get the information needed regarding the real life challenges their patients face without coming across as intrusive. Providers can then offer compassionate support and resources to improve health outcomes.

Through the sensitive application of virtual care and digital technologies to improve access for those most vulnerable, providers and health plans can bridge gaps in care and support. These proof points show that, properly applied, such tools can boost outcomes and engagement while reducing healthcare costs.

Carrie Nelson, MD, MS, FAAFP, is Chief Medical Officer, Amwell.